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Bone turnover markers (CTX and P1NP): do you have a baseline?
Currently i am on forteo therapy with a couple bone markers tests done. However, I didnt have ctx or p1np tested before the start of forteo as a baseline, regrettably.
It is known that the CTX value varies greatly among different individuals, with a very wide range. For post menopausal women, the range could be 34 - 1037 pg/ml; while for perimenopausal women 34-635 pg/ml. Different labs also have a slight different range values.
CTX, a bone resorption (breakdown) marker, is heavily influenced by a number of factors, such as food intake, circadian variation and exercise/life style, etc.
Bone remodeling is a dynamic and complex process. CTX itself may not fully reveal the whole picture. The bone building marker P1NP, is a lot less influenced by external factors. Taking both into consideration at the same time may shed more lights than looking at CTX or P1NP alone.
For those who had their CTX and P1NP tested before treatment with a bone drug, could you share the results if you don't mind? Thanks a lot!
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@gracie7 you are on the right path... being proactive about your diet, supplements if necessary, exercise and fall prevention is the foundation of management; more importantly, questioning the right drug of choice to start the treatment journey.
Have you had a DXA scan and a FRAX/FRAXPlus risk assessment?
@gently had a great post re bone turnover markers.
Regarding the Prolia recommendation: it's an antiresorptive (slow down bone breakdown) that carries a unique "rebound" risk if stopped. It essentially requires a lifetime commitment or a carefully planned transition to another antiresorptive (a strong bisphosphonate), which adds significant long term complexity. It also complicates future treatment sequencing in the event you need any bone builders. Because of this, it's often not the first line choice -especially when anabolics (bone builders such as Forteo or Tymlos) have shown in several studies to be very effective for glucocorticoid-induced osteoporosis. Discussing with your doctors about the right drug to start is absolutely crucial, as your instinct tells you.
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2 Reactions@gently, thank you so much for the information. I watched several of his videos and will watch more....very informative. One of the aspects of a med for me is that it isn't a long-lasting med, rather a daily or weekly med so if something isn't working, I am not locked in for 6-12 months and it looks like Forteo would work; however, I have high calcium levels with no supplementation and often deal with pseudo gout so it might not work, but I will ask.
When reading Keith McCormick's book, I think a treatment that slows down bone resorption would create a better balance as my P1NP seems ok, but I am not a doctor so will have to ask that too. Thanks again for your input; this forum is very helpful. Best - Gracie
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1 Reaction@mayblin, Thank you! It seems I can't get enough information and you all are wonderful.
I wonder if me now being totally off prednisone, not drinking sodas or taking supplements that I now read increase osteoclast activity and forcing myself to eat much more protein might make a difference in the result??? Along with exercise and weights of course. Best - Gracie
@mayblin, oh sorry, I forgot to answer you. I did have a DXA scan and it showed I was osteopenia everywhere except the left hip which was -2.8. I think the REM scan was more accurate as one outlier of the -2.8 showed an inaccurate result....unfortunately. Thanks - Gracie
@gracie7 I think your doctors will most likely base treatment decisions on DXA results, with FRAX also playing a role.
Glucocorticoids affect bone in a unique way, and coming off prednisone is probably the most important “stop-loss” step you can take right now. Lifestyle measures provide an essential foundation for bone health, but they’re unlikely to fully reverse the effects of prednisone. Wish you the best on this journey.
@mayblin - I now understand the unique damage from prednisone and am quite ticked off that I was not told about side effects; and my records showed I had osteopenia when I started on it. It surely worked miracles after the first couple doses and perhaps I should have known to ask side effects, but I have always trusted doctors (my naivety I suppose). Because of my experience with a doctor not helping with preventing or minimizing the side effects, I am now very skeptical of the quite curt advice to simply move on with Prolia with no discussion.
I have no health issues other than pseudo gout that flares up and with that no one knows what causes it or how to prevent it. The only pharmaceutical I take is colchicine and I am aware of the side effects now....again by my own research!
If my rheumatologist had taken time to talk about the plan, my DXA results (osteopenia every point except -2.8 left femur neck) would never warrant such a powerful med.
One thing I am doing (from all the wonderful experiences with this forum) regarding diet and supplements....I eat 6 prunes with a cup of cottage cheese either for breakfast or lunch and have learned that MK4 (45mg) is the best K vitamin for bone health. I continue with a ton of other supplements, too many to list and will let you know if what I am doing is making a difference with the next blood test/scan. Thank you SO much for all the discussions.
OH and I grow lots of veggies and love the fresh beet greens, sautéed in oil and garlic....no kidney issues yet, thank God. Best - gracie
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3 Reactions@kristie2 - I am also taking BHRT while on Evenity. I have one more Evenity injection left before having to decide next steps.
Did you following Evenity w/any other drug or is the BHRT sufficient to hold the gains? That will be my preferred course of action.
@mayblin - did you take any other bone drug after Tymlos or just depend on HRT to maintain the gains? I have started HRT 3 months prior to the end of my Evenity treatment. What optimal hormone ranges are you looking for?
@singingbones i used Forteo then transitioned to HRT with no other osteoporosis meds, so estrogen serves as an antiresorptive during my maintenance phase.
Since CTX (resorption) tends to have a small rebound toward or above baseline within 1–3 months of stopping Evenity, and the fact that it takes a few months for estrogen to reach max effect, having 3-4mos of HRT already in place like you have is a huge plus in my view.
Have you checked your CTX labs? I think it’s a great way to verify HRT's effect. My doctors don't focus on serum estradiol levels, but they check my CTX periodically and order annual DXA scans.
Hope this info helps somewhat. Best of luck and please keep us posted.
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1 Reaction@mayblin - My ortho dr does not plan to run any BTM as far as I know b/c my DXA is due at the end of the Evenity treatment & she says that makes it unnecessary to run the markers. She did run the P1NP & BSAP (bone-specific Alkaline Phosphatase) before starting me on Evenity, however.
Assuming she doesn't order the BTMs, I plan to ask my PCP if she will run them so I have a baseline of my own even if it's already impacted by residual Evenity & early HRT. If she won't order, then I'll self-pay for those two as well as CTX.
After all my research, I see no reason why HRT won't hold the post-drug gains. My BTMs & perhaps a REMS scan can both serve to check in on my progress or regression.
Thanks for sharing your story/strategy & yes, I'll keep you posted.
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